Health IT’s woes are a moral problem that needs to be solved

I was dining at a friend’s house recently after a long day in the hospital. He has just bought a beautiful new home with his rapidly expanding family, and like anyone who has just moved into a new house, his spare time is invariably spent working on getting everything in order and undertaking small upgrades to make the new place as perfect as possible.

He’s quite DIY-oriented (unlike myself) and was spending a lot of time doing minor construction work. When I asked him why he didn’t just hire someone else to do the work, he told me that he’d rather just do it himself and that it was far better and more enjoyable than “just going into the hospital to play around with computers all day.”

I found this a profound statement, and sad on a number of different levels. His hospital had a new computer system installed a few months ago, and like a lot of physicians — especially those in generalist specialties — he was now finding himself spending the vast majority of his day staring at a screen, typing and clicking away. He is a physician who really enjoys clinical medicine, values his time with patients, and didn’t go to medical school to do a desk job (like all doctors).

In fact, if my own experience is anything to go by, I wouldn’t be surprised if, during a 12-hour day, patients are lucky if their doctor spends 1 to 1.5 hours total with them. Think long and hard about that statistic, because it’s a disaster for the practice of medicine and for our patients. A typical scenario goes something like this: 5 minutes with you and then 20 to 25 minutes navigating an inefficient and cumbersome system to document what’s just happened! Interacting with a computer during the actual encounter is even worse, and not appreciated by patients when they see their doctor turning around and looking at a screen every few seconds instead of talking to them.

The answer, however, isn’t to take the technology away and go back to the ancient days of pen and paper, but rather to design better and more optimal solutions: with a simple acknowledgment that the best IT of the future will be that which is seen and not heard. Electronic medical records and physician order entry systems that are quick, super easy to use, and properly reconciled with frontline clinical workflow.

Physicians simply cannot spend 80 to 90 percent-plus of their day sitting down at a computer terminal. It’s not what being a doctor is all about. So much of medicine is about communication and yes, much of it is also still an art. The same dismay would result if you turned another profession that views itself as an art upside down and into a screen-staring job (whether it be a sportsperson, a film producer, or a teacher). Whatever we can do to tip the scale back towards patient care, must be done. Although it’s unrealistic, and also nonsensical, to think that doctors could ever spend 100 percent of their day with their patients, there must be a palpable swing towards direct care time. This would not only be good for patients, but also increase productivity and efficiency — as doctors will also be able to see more patients in a meaningful way.

Going back to my friend, who now equates being a physician with going into hospital and playing around with the computer all day, the situation is not just an impractical one, but a big moral one too. Moral because it has so many consequences in terms of reducing job satisfaction for a noble, caring and hard-working profession. Moral because it makes every physician forget why they went into medicine in the first place. And most of all, moral because it robs our patients of the care they deserve when their physician is more preoccupied with documenting the encounter than living it.

Physician Coaching by KevinMD

Health IT’s woes are a moral problem that needs to be solved 9 comments

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southerndoc1

“Moral because it has so many consequences in terms of reducing job satisfaction for a noble, caring and hard-working profession:” They don’t care.

“Moral because it makes every physician forget why they went into medicine in the first place:” They don’t care.

“And most of all, moral because it robs our patients of the care they deserve when their physician is more preoccupied with documenting the encounter than living it:” They don’t care.

Reality – deal with it.

SarahJ89

Oh, how I wish I could hate your comment a zillion times. But I cannot, because it is so true. The entire concept of ethics and morality–by which I mean integrity and kindness to our fellow humans (and other species)–has been run over by the corporate bus.

RES

When my wife started private practice (Peds) in 1988 we visited IBM in Manhattan. They already had an early medical voice recognition system which we tried out. It had two valuable features: it was intended to be speaker-independent, but it also retained the audio it had heard. It worked, but was very costly. We hoped it would soon be practical for use in the office so that a transcription of each visit could be retained, but it wasn’t there yet.
From what I read here it still isn’t. It is extraordinary that with computers more than 2000 times faster than then that human ‘scribes’ are being recommended as a work-around, and that apparently current EMRs do not use speech recognition, or scrap the audio if they do.
Happily, paper charts worked well enough until my wife retired, still with no EMR. There was no way to ever get the money back in peds short of running a medicaid mill, and no system that seemed to offer any improvement in the visit, the office, or ease of billing. We tried e-prescriptions but the pharmacies appeared to ignore them until the parents showed up to collect the medicine, then told them it would be half an hour- look around the store.

Thomas D Guastavino

Years ago my practice, on our own and after doing our due diligence, decided that it made sense to spend $150,000 to upgrade to a digital X-Ray system. The only financial incentive was accelerated depreciation. No bribes, threats or meaningful use. When we applied the same due diligence to EMR it was clear from the beginning that it it was going to cause more problems then it was worth. The moral takeaway: When you a make a deal with the devil you are going to get burned, especially if you go into it blind.

Thomas D Guastavino

When people ask me whether I think Obamacare is good or bad I say, it depends on who you are. Like every other monumental change, Obamacare created both winners and losers. At the top of the list of winners are the EMR companies.